Hemodialysis in lithium poisoning: what is the evidence?

3.5 out of 5 stars Extracorporeal Treatment for Lithium Poisoning: Systematic Review and Recommendations from the EXTRIP Workgroup. Decker BS et al. Clin J Am Soc Nephrol 2015 Jan 12 [Epub ahead of print] Abstract The purpose of this review, from the Extracorporeal Treatments in Poisoning (EXTRIP) workgroup, was to give evidence-based recommendations related to use of hemodialysis and other extracorporeal modalities in the treatment of lithium toxicity. The goal of enhanced elimination in lithium poisoning is to avoid the syndrome of irreversible lithium-effectuated nerutoxicity (SILENT), which causes persistent cerebellar dysfunction after prolonged exposure of the CNS to high levels of lithium. Using elaborate methodology, the EXTRIP group reviewed relevant literature, identifying 166 papers (describing 228 patients) in multiple languages that merited inclusion. Most of these were case reports yielding, in the words of the authors, “a very low quality of evidence for all recommendations.” In other words, there is no real evidence, and the recommendations and (weaker) suggestions are based mostly on the opinions of the workgroup members. Now, the EXTRIP group is comprised of some various smart clinicians from a variety of specialties, including medical toxicology, nephrology, and intensive care. Their opinions are definitely worth reading and considering carefully. For example, this is a summary of their proposed indications for extracorporeal treatment (ECTR &...
Source: The Poison Review - Category: Toxicology Authors: Tags: Medical extracorporeal treatment extrip hemodialysis indications lithium poisoning Source Type: news